Extracorporeal Life Support: Four Decades and Counting

Abstract

Extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is a form of heart lung bypass that is used to support neonates, pediatrics, and adult patients with cardiorespiratory failure for days or weeks till organ recovery or transplantation. Venoarterial (VA) and venovenous (VV) ECLS are the most common modes of support. ECLS circuit components and monitoring have been evolving over the last 40 years. The technology is safer, simpler, and more durable with fewer complications. The use of neonatal respiratory ECLS use has been declining over the last two decades, while adult respiratory ECLS is growing especially since the H1N1 influenza pandemic in 2009. This review provides an overview of ECLS evolution over the last four decades, its use in neonatal, pediatric and adults, description of basic principles, circuit components, complications, and outcomes as well as a quick look into the future.

Ischemia-reperfusion Injury in the Transplanted Lung: A Literature Review

“… 172 - 176 Although there have been substantial improvements, ECMO is still associated with significant complications, most notably bleeding events, and requires high resource consumption. 177 , 178 In LIRI, venoarterial (VA) ECMO is more beneficial, as venovenous cannulation cannot reduce pulmonary arterial output and vascular stress. 179 , 180 Furthermore, severe PGD secondary to LIRI can be accompanied by right ventricular dysfunction that is not supported by venovenous ECMO.…”

Bilateral lung transplantation during pregnancy after ECMO for influenza-A caused ARDS

“…[15][16][17] ECMO is therefore considered safe and effective during pregnancy, but should only be maintained until pulmonary recovery, or in the absence of recovery, until lung transplantation. 18 The benefits of ECMO therapy over conventional ventilation remain controversial, suggesting the need for further research comparing therapeutic interventions. 15,17 In our patient, different therapeutic options were discussed, including termination of pregnancy, continuation of pregnancy and ECMO-bridge to recovery, and lung transplantation.…”

“…With ECMO, maternal survival ranges from 74.6% to 77.8%, and approximately 66% of fetuses survive 15‐17 . ECMO is therefore considered safe and effective during pregnancy, but should only be maintained until pulmonary recovery, or in the absence of recovery, until lung transplantation 18 15,17 …”

“… 15 , 16 , 17 ECMO is therefore considered safe and effective during pregnancy, but should only be maintained until pulmonary recovery, or in the absence of recovery, until lung transplantation. 18 The benefits of ECMO therapy over conventional ventilation remain controversial, suggesting the need for further research comparing therapeutic interventions. 15 , 17 …”

Editorial: Insights and advances in pediatric critical care

“…Despite advances in the management of pediatric acute respiratory distress syndrome (PARDS) and shock, once refractory to conventional treatment these patients have very high risk of death. Extracorporeal therapies have shown promise in such cases with increased survival rates in refractory shock and PARDS ( 9 ). Survival with ECMO in neonates has improved over the decades.…”